糖尿病足溃疡合并下肢动脉病变的临床特点及相关危险因素

Clinical characteristics and risk factors of lower extremity arterial disease in patients with diabetic foot ulcer

目的研究糖尿病足溃疡(DFU)合并下肢动脉病变(LEAD)的临床特点,分析DFU合并LEAD相关危险因素。方法收集2017年1月~2019年12月南方医科大学南方医院内分泌代谢科住院治疗的650例DFU患者的临床资料,并进行随访。根据DFU是否合并LEAD分为LEAD组与非LEAD组,分析两组一般资料情况,使用Logistic回归分析DFU合并LEAD的相关危险因素。结果650例DFU患者中,72.4%的患者合并LEAD。平均随访时间约3.5个月,DFU平均愈合时间为2.55个月,其中愈合453例,截肢183例。两组年龄、住院费用、舒张压(DBP)、糖化血红蛋白(HbA1c)、血脂、病程、踝肱指数(ABI)、愈合时间、吸烟率、临床结局、Wagner分级、影像学结果其差异有统计学意义(P<0.05)。多因素Logistic回归显示年龄(OR=1.070,95%CI 1.049-1.091)、吸烟史(OR=2.013,95%CI 1.268-3.195)、DBP下降(OR=0.980,95%CI 0.963-0.997)为DFU合并LEAD的独立危险因素,愈合时间长则为DFU合并LEAD的临床特点。结论DFU患者合并LEAD发病率高,易致残、死亡,具有高龄、高吸烟率、愈合时间更长的特点,特别发现舒张压的下降也是危险因素之一。

Objective To investigate the clinical characteristics of lower extremity arterial disease(LEAD)and its risk factors in patients with diabetic foot ulcer(DFU).Methods We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January,2017 and December,2019.We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients.Results Among the 650 DFU patients,470(72.4%)had LEAD.The patients were followed up for a mean of 3.5 months,and the mean healing time of DFU was 2.55 months;healing of DFU occurred in 453 patients and 183 patients received amputation.The patients with LEAD and those without LEAD differed significantly in age,hospitalization costs,diastolic blood pressure(DBP),glycated hemoglobin,blood lipid levels,disease course,ankle brachial index,healing time,smoking history,clinical outcomes,Wagner grade and imaging results(P<0.05).Multivariate logistic regression analysis identified age(OR=1.070,95%CI:1.049-1.091),smoking history(OR=2.013,95%CI:1.268-3.195),and a decreased DBP(OR=0.980,95%CI:0.963-0.997)as independent risk factors for LEAD in DFU patients.A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD.Conclusion DFU patients have a high incidence of LEAD,which leads to high rates of disability and mortality and is associated with an advanced age,high smoking rate and longer healing time.Adecreased DBP is also a risk factor for LEAD in DFU patients.